Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

Huang, Lei; Li, Chao; Tang, Miao; Jun, Li Ya; Liu, Ling; Ying, Pu Yan; Han, Peng Xiao; Xu, Bo; Tan, Xin Quan

doi:10.1111/aas.13509

Cited by 22 publications

(26 citation statements)

References 26 publications

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“…The uctuations in the HR, SBP, and DBP values in the patients of the nasal drops group were not observed to exceed 15% of the baseline value at any point in time, which was identical to the ndings of the study by Yao et al Another study showed that the HR and SBP uctuations with dexmedetomidine 2 µg / kg nasal use were within 17.5% and 16.1% [8]. Based on the outcomes of the study by Lei et al, bradycardia and blood pressure values of all the children in the 9986 cases with dexmedetomidine sedation were within the normal range [17], demonstrating that the effect of dexmedetomidine nasal use on the hemodynamics was insigni cant. Compared with the baseline value, the HRs in the intravenous group patients decreased most signi cantly at 1 min to 26.52% (79.3 ± 14.08 vs. 107.92 ± 14.91; p < 0.05), and rose to 12.11% (94.85 ± 8.83 vs.) at 5 min, which is similar to the outcomes of the study by Jooste [18].…”

Section: Discussionsupporting

confidence: 84%

“…In the ward, the EA incidences in the nasal, intravenous injection, and control groups were 20.00%, 17.50%, and 70.00%, respectively. Statistical differences between the nasal drop and control groups (p < 0.05, OR = 0.107, 95% CI [0.038-0.300]), and intravenous injection, and control groups (p < 0.05, OR = 0.091, 95% CI [0.032-0.262]) were recorded.…”

Section: Resultsmentioning

confidence: 97%

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Nasal and Intravenous Administration of Dexmedetomidine to Prevent the Emergence Agitation After the Vascular Interventional Surgery in Children: A Randomized, Double-blind, Controlled Study

Huang

Liu

Yanying

et al. 2020

Preprint

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Abstract Introduction: Dexmedetomidine reduces the incidences of postanesthetic restlessness and hemodynamic fluctuations in children within acceptable ranges. Dexmedetomidine nasal drop prior to the surgery reduces the EA after anesthesia. There are several studies that compare the effects of dexmedetomidine nasal drop and intravenous injection, in which they were administered prior to the induction of anesthesia.This double-blind, randomized, controlled study was performed to compare the effects of dexmedetomidine nasal drop and intravenous injection on postoperative emergence agitation (EA), sedation, and hemodynamics in pediatric patients prior to and post surgery. METHODS: We randomly divided 120 children, who were enrolled in this study, into the control, dexmedetomidine nasal, and dexmedetomidine intravenous injection groups. The dexmedetomidine dose for nasal use was 2 µg / kg, and that for intravenous injection was 0.8 µg / kg. The nasal dose and the intravenous injection were, respectively, administered 30 and 10 min prior to the surgery being culminated. The EA was recorded within 30 min in the post-anesthesia care unit (PACU) and within 3 h in the ward. The incidence of EA, Ramsay scores, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and adverse events were recorded. RESULTS: In the PACU, the EA incidences in the nasal dose, intravenous injection, and control groups were 27.50%, 20.00%, and 52.50%, respectively. Statistical differences between the nasal and control groups (p < 0.05, OR = 0.343, 95% CI [0.135–0.871]) and the intravenous and control groups (p < 0.05, OR = 0.226, 95% CI [0.084–0.610]) were recorded. The EA incidence was not statistically different between the nasal and intravenous injection groups. The proportions of Propofol users were 52.50%, 27.50%, and 92.50% in the nasal spray, intravenous injection, and control groups, respectively. Statistically significant differences among the three groups (p < 0.05) were observed. The EA incidences in the nasal drop, intravenous injection, and control groups in the ward were 20.00%, 17.50%, and 70.00%, respectively. Statistically significant difference between the nasal drop and control groups (p < 0.05, OR = 0.107, 95% CI [0.038–0.300]) and the intravenous and control groups (p < 0.05, OR = 0.091, 95% CI [0.032–0.262]) were found. There was no significant difference in EA incidence between the nasal drop and intravenous injection groups. CONCLUSION: Dexmedetomidine nasal and intravenous administrations have similar effects in reducing the EA incidence within 30 min in the PACU and 3 h in the ward. In the PACU the sedation depth in the intravenous injection group was greater than that in the nasal drop group and within the 3 h in the ward, the depth of sedation was the same for both administration routes. The intravenous injection affects the HR more than the nasal drop within 5 min of administration. Thus, dexmedetomidine nasal drop prior to the culmination of the surgery is more suitable for PACU and ward sedation to prevent EA. Trial registration: The registration number ,ChiCTR1900021325(http://www.chictr.org.cn/index.aspx),The date of registration,02/15/2019.

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Section: Discussionsupporting

confidence: 84%

Section: Resultsmentioning

confidence: 97%

Nasal and Intravenous Administration of Dexmedetomidine to Prevent the Emergence Agitation After the Vascular Interventional Surgery in Children: A Randomized, Double-blind, Controlled Study

Huang

Liu

Yanying

et al. 2020

Preprint

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“…Sedation failure with supplemental dose was defined as follows: ① After supplemental dosing with chloral hydrate, the patients could not achieve satisfactory depth of sedation within 30 min;② Failure to complete the diagnostic procedure even after achievement of the anticipated depth of sedation [5]; ③ The occurrence of severe adverse events which prevents the diagnostic procedures continuing; ④ The need of other medications in addition to chloral hydrate.…”

Section: Definitionsmentioning

confidence: 99%

“…Midazolam, chloral hydrate, and dexmedetomidine that can be administrated orally or transmucosally are considered as the best choices. However, sedative-hypnotics, such as midazolam, chloral hydrate, dexmedetomidine, have a certain failure rate about 1% [3], 3.4% [4], 5.7% [5], respectively. Failure of sedation may lead to cost and time detriment, as well as dissatisfaction from guardians.…”

Section: Introductionmentioning

confidence: 99%

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Sleep deprivation did not enhance the success rate of chloral hydrate sedation for non-invasive procedural sedation in pediatric patients

Cui

Guo

et al. 2021

PLoS ONE

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Study objective In Asian countries, oral chloral hydrate is the most commonly used sedative for non-invasive procedures. Theoretically, mild sleep deprivation could be considered as one of assisted techniques. However, there is no consensus on sleep deprivation facilitating the sedation during non-painful procedures in children. The aim of our study is to analyze the clinical data of children undergoing non-invasive procedural sedation retrospectively and to evaluate the association between mild sleep deprivation and sedative effects in non-invasive procedures. Measurements Consecutive patients undergoing chloral hydrate sedation for non-invasive procedures between December 1, 2019 to June 30, 2020 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with sleep deprivation and non-sleep deprivation. The primary outcome was the failure rate of sedation with the initial dose. The secondary outcomes included the failure rate of sedation after supplementation of chloral hydrate, the incidence of major and minor adverse events, initial and supplemental dose of chloral hydrate, and the length of sedation time. Main results Of the 7789 patients undergoing chloral hydrate sedation, 6352 were treated with sleep deprivation and 1437 with non-sleep deprivation. After propensity score matching, 1437 pairs were produced. The failure rate of sedation with initial chlorate hydrate was not significantly different in two groups (8.6% [123/1437] vs. 10.6% [152/1437], p = 0.08), nor were the failure rates with supplemental chlorate hydrate (0.8% [12/1437] vs. 0.9% [13/1437], p = 1) and the length of sedation time (58 [45, 75] vs. 58 [45, 75] min; p = 0.93). Conclusions The current results do not support sleep deprivation have a beneficial effect in reducing the pediatric chloral hydrate sedation failure rate. The routine use of sleep deprivation for pediatric sedation is unnecessary.

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Clinical Use of Adrenergic Receptor Ligands in Acute Care Settings

Langnas,

Maze

2024

Handbook of Experimental Pharmacology

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Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

Cited by 22 publications

References 26 publications

Nasal and Intravenous Administration of Dexmedetomidine to Prevent the Emergence Agitation After the Vascular Interventional Surgery in Children: A Randomized, Double-blind, Controlled Study

Nasal and Intravenous Administration of Dexmedetomidine to Prevent the Emergence Agitation After the Vascular Interventional Surgery in Children: A Randomized, Double-blind, Controlled Study

Sleep deprivation did not enhance the success rate of chloral hydrate sedation for non-invasive procedural sedation in pediatric patients

Clinical Use of Adrenergic Receptor Ligands in Acute Care Settings

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